scholarly journals Anteromedial instability of the knee

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0029
Author(s):  
Guido Wierer ◽  
Danko Milinkovic ◽  
James Robinson ◽  
Andreas Weiler ◽  
Christian Fink ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Stress Test ◽  
Optical Tracking ◽  
Minor Role ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Intact State ◽  
Dial Test ◽  
Tibial Translation ◽  
Deficient Knee

Aims and Objectives: Anteromedial rotatory instability (AMRI) may result from combined lesions to the medial capsuloligamentous structures and anterior cruciate ligament (ACL). However, the contribution made by individual structures to controlling AMRI remains controversial. The purpose of the present study was to determine how the medial structures and ACL contribute to restraining simulated clinical laxity. Materials and Methods: Twenty-eight paired, fresh-frozen human cadaveric knees were tested in a six-degree of freedom robotic setup. After sequentially cutting the dMCL, sMCL, POL, and ACL in 4 different cutting orders, the following simulated laxity tests were applied at 0°, 30°, 60°, and 90° of knee flexion: 4 Nm external tibial rotation (ER), 4 Nm internal tibial rotation (IR), 8 Nm valgus rotation (VR) and anteromedial translation (AMT) - combined 89 N anterior tibial translation and 4 Nm ER. Knee kinematics (AMT, ER, IR, VR) were recorded in the intact state and after each cut using an optical tracking system. Differences in medial compartment translation and rotation from the intact state were then analyzed using Visual 3D. The kinematic data for each tested state, load, and flexion angle were analyzed using a 2-factor repeated-measures analysis of variance (ANOVA) and post-hoc Bonferroni corrections for multiple comparisons. Study Design: Controlled laboratory study. Results: The sMCL was the most important restraint to AMT (1.3 mm, 3.9 mm, 6.4 mm, 6.1 mm in 0°, 30°, 60°, 90°, respectively; P < 0.05), ER (1.8°, 4.4°, 6.3°, 5.3° in 0°, 30°, 60°, 90°, respectively; P < 0.01), and VR (4.1°, 4.8°, 5.8° in 30°, 60°, 90°, respectively; P < 0.05) at all flexion angles. Cutting the proximal tibial attachment of the sMCL caused no significant increase in laxity if the distal sMCL attachment remained intact. The dMCL was a minor restraint to AMT (1.3 mm, 1.8 mm, 1.6 mm in 0°, 30°, 60°, respectively; P < 0.05) and ER (1.5°, 1.2°, 1.1°, 1.0° in 0°, 30°, 60°, 90°; P < 0.05). The POL controlled IR near extension (3.3° in 0°; P < 0.05) and was a secondary restraint to AMT and ER in the ACL + MCL deficient knee. The ACL contributed in restraining AMT (4.0 mm, 6.2 mm, 4.2 mm, 3.0 mm in 0°, 30°, 60°, 90°, respectively; P < 0.01) and was a secondary restraint to ER and VR in the MCL deficient knee. Conclusion: The sMCL was the primary restraint to anterior subluxation of the medial tibial plateau, tibial ER and valgus rotation, which constitutes pathological laxity in AMRI. The dMCL and POL play a more minor role in restraining AMRI. Clinical Relevance: The simulated clinical tests (anteromedial drawer, external/internal rotation dial test and valgus stress test) allow determination of potential injury patterns causing AMRI. Based on the present data we propose a classification of anteromedial instability and suggest that for surgical treatment of AMRI it is important to address the sMCL.

Effect of Femoral Antetorsion on Tibiofemoral Translation and Rotation in the Anterior Cruciate Ligament Deficient Knee

2018 ◽  
Vol 32 (10) ◽  
pp. 960-965
Author(s):  
Mohamed Omar ◽  
Yousif Al Saiegh ◽  
Emmanouil Liodakis ◽  
Timo Stuebig ◽  
Daniel Guenther ◽  
...  
Keyword(s):  
Distal Femur ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Femoral Antetorsion ◽  
Anterior Drawer ◽  
Tibial Translation ◽  
Acl Deficient ◽  
Deficient Knee

AbstractWe aimed to investigate how increased or decreased femoral antetorsion would affect the biomechanics of the knee in an anterior cruciate ligament (ACL)-deficient cadaveric model. We hypothesized that external or internal rotation of the distal femur, achieved through a femoral osteotomy, would affect the magnitude of tibiofemoral translation and rotation. Navigated measurements of tibiofemoral translation and rotation during the anterior drawer, Lachman, and pivot shift tests were performed on six whole-body cadaveric specimens in each of the following four conditions: native, ACL-deficient knee, ACL-deficient knee and 20-degree internal distal femur rotation, and ACL-deficient knee and 20-degree external distal femur rotation. Increased femoral antetorsion significantly reduced anterior tibial translation in the ACL-deficient knee during the anterior drawer, Lachman, and pivot shift tests (p < 0.05). Conversely, decreasing femoral antetorsion resulted in an increase in anterior tibial translation in the anterior drawer (nonsignificant), Lachman (p < 0.05), and pivot shift (p < 0.05) tests. Internally rotating the distal femur significantly reduced the magnitude of tibial rotation during the pivot shift test in the ACL-deficient knee (p < 0.05), whereas external rotation of the distal femur significantly increased tibial rotation (p < 0.05). The magnitude of femoral antetorsion affects tibiofemoral translation in an ACL-deficient cadaveric mode. Internally rotating the distal femur 20 degrees reduced the magnitude of tibial translation and rotation similar to that of the native knee, whereas externally rotating the distal femur aggravated translational and rotational instability.

scholarly journals The correlation between posterior tibial slope and dynamic anterior tibial translation and dynamic range of tibial rotation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
M.J.M Zee ◽  
M.N.J Keizer ◽  
L Dijkerman ◽  
J.J.A.M van Raaij ◽  
J.M. Hijmans ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Dynamic Range ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Wedge Osteotomy ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Before And After ◽  
Anterior Cruciate ◽  
Tibial Translation

Abstract Purpose The amount of passive anterior tibial translation (ATT) is known to be correlated to the amount of posterior tibial slope (PTS) in both anterior cruciate ligament-deficient and reconstructed knees. Slope-altering osteotomies are advised when graft failure after anterior cruciate ligament (ACL) reconstruction occurs in the presence of high PTS. This recommendation is based on studies neglecting the influence of muscle activation. On the other hand, if dynamic range of tibial rotation (rTR) is related to the amount of PTS, a “simple” anterior closing-wedge osteotomy might not be sufficient to control for tibial rotation. The purpose of this study was to evaluate the correlation between the amount of PTS and dynamic ATT and tibial rotation during high demanding activities, both before and after ACL reconstruction. We hypothesized that both ATT and rTR are strongly correlated to the amount of PTS. Methods Ten subjects were studied both within three months after ACL injury and one year after ACL reconstruction. Dynamic ATT and dynamic rTR were measured using a motion-capture system during level walking, during a single-leg hop for distance and during a side jump. Both medial and lateral PTS were measured on MRI. A difference between medial and lateral PTS was calculated and referred to as Δ PTS. Spearman’s correlation coefficients were calculated for the correlation between medial PTS, lateral PTS and Δ PTS and ATT and between medial PTS, lateral PTS and Δ PTS and rTR. Results Little (if any) to weak correlations were found between medial, lateral and Δ PTS and dynamic ATT both before and after ACL reconstruction. On the other hand, a moderate-to-strong correlation was found between medial PTS, lateral PTS and Δ PTS and dynamic rTR one year after ACL reconstruction. Conclusion During high-demand tasks, dynamic ATT is not correlated to PTS. A compensation mechanism may be responsible for the difference between passive and dynamic ATT in terms of the correlation to PTS. A moderate-to-strong correlation between amount of PTS and rTR indicates that such a compensation mechanism may fall short in correcting for rTR. These findings warrant prudence in the use of a pure anterior closing wedge osteotomy in ACL reconstruction. Trial registration Netherlands Trial Register, Trial 7686. Registered 16 April 2016—Retrospectively registered. Level of evidence Level 2, prospective cohort study

scholarly journals Determination of the Position of the Knee at the Time of an Anterior Cruciate Ligament Rupture for Male Versus Female Patients by an Analysis of Bone Bruises

2018 ◽  
Vol 46 (7) ◽  
pp. 1559-1565 ◽  
Author(s):  
Kwadwo A. Owusu-Akyaw ◽  
Sophia Y. Kim ◽  
Charles E. Spritzer ◽  
Amber T. Collins ◽  
Zoë A. Englander ◽  
...  
Keyword(s):  
Female Athletes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Male And Female ◽  
Mri Scans ◽  
Internal Tibial Rotation ◽  
Anterior Cruciate ◽  
Tibial Translation

Background: The incidence of anterior cruciate ligament (ACL) ruptures is 2 to 4 times higher in female athletes as compared with their male counterparts. As a result, a number of recent studies have addressed the hypothesis that female and male patients sustain ACL injuries via different mechanisms. The efficacy of prevention programs may be improved by a better understanding of whether there are differences in the injury mechanism between sexes. Hypothesis/Purpose: To compare knee positions at the time of a noncontact ACL injury between sexes. It was hypothesized that there would be no differences in the position of injury. Study Design: Controlled laboratory study. Methods: Clinical T2-weighted magnetic resonance imaging (MRI) scans from 30 participants (15 male and 15 female) with a noncontact ACL rupture were reviewed retrospectively. MRI scans were obtained within 1 month of injury. Participants had contusions associated with an ACL injury on both the medial and lateral articular surfaces of the femur and tibia. Three-dimensional models of the femur, tibia, and associated bone bruises were created via segmentation on MRI. The femur was positioned relative to the tibia to maximize bone bruise overlap, thereby predicting the bone positions near the time of the injury. Flexion, valgus, internal tibial rotation, and anterior tibial translation were measured in the predicted position of injury. Results: No statistically significant differences between male and female patients were detected in the position of injury with regard to knee flexion ( P = .66), valgus ( P = .87), internal tibial rotation ( P = .26), or anterior tibial translation ( P = .18). Conclusion: These findings suggest that a similar mechanism results in an ACL rupture in both male and female athletes with this pattern of bone bruising. Clinical Relevance: This study provides a novel comparison of male and female knee positions at the time of an ACL injury that may offer information to improve injury prevention strategies.

scholarly journals The Influence of Graft Tensioning Sequence on Tibiofemoral Orientation during Bicruciate and Posterolateral Corner Knee Ligament Reconstruction: A Biomechanical Study

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0006
Author(s):  
Gilbert Moatshe ◽  
Jorge Chahla ◽  
Alex Brady ◽  
Grant Dornan ◽  
Kyle Muckenhirn ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Posterolateral Corner ◽  
Tibial Rotation ◽  
Knee Ligament ◽  
Intact State ◽  
Knee Ligament Reconstruction ◽  
Significant Difference ◽  
Tibial Translation

Objectives: During a multiple knee ligament reconstruction, the graft tensioning order may influence the final tibiofemoral orientation and corresponding knee kinematics. Therefore, the objective of this study was to biomechanically evaluate the effect of different graft tensioning sequences on knee tibiofemoral orientation following multiple knee ligament reconstruction in a bicruciate ligament (anterior cruciate ligament [ACL] and posterior cruciate ligament [PCL]) with posterolateral corner [PLC] injured knee. Methods: Ten non-paired, fresh-frozen human cadaveric knees were utilized for this study. Following reconstruction of both cruciate and posterolateral corner ligaments and proximal graft fixation, each knee was randomly assigned to each of four graft tensioning order groups: (1) PCL → ACL → PLC, (2) PCL → PLC → ACL, (3) PLC → ACL → PCL and (4) ACL → PCL → PLC. The tibiofemoral orientation after graft tensioning was measured and compared to the intact states. Results: Tensioning the ACL first (tensioning order 4) resulted in posterior displacement of the tibia at 0° by 1.7 ± 1.3 mm compared to the intact state (p=0.002) (Figure 1). All tensioning orders resulted in significantly increased anterior tibial translation compared to the intact state at higher flexion angles ranging from 2.7 mm to 3.2 mm at 60° and 3.1 mm to 3.4 mm at 90° for tensioning orders 1 and 2 respectively (all p<0.001). There was no significant difference in tibiofemoral orientation in the sagittal plane between the tensioning orders at higher flexion angles. All tensioning orders resulted in increased internal tibial rotation (all p<0.001). Tensioning and fixing the PLC first (tensioning order 3) resulted in the most increases in internal rotation of the tibia; 2.4° ± 1.9°, 2.7° ± 1.8° and 2.0° ± 2.0° at 0°, 30° and 60° respectively (Table 1). Conclusion: None of the tensioning orders restored intact knee tibiofemoral orientation. Tensioning the posterolateral corner first should be avoided in bicruciate knee ligament reconstruction with a concurrent posterolateral corner reconstruction because it significantly increased tibial internal rotation. We recommend that the PCL be tensioned first, followed by the ACL to avoid posterior translation of the tibia in extension where the knee is primarily loaded with most activities and finally the PLC. [Figure: see text][Table: see text]

The influence of the medial meniscus in different conditions on anterior tibial translation in the anterior cruciate deficient knee

2014 ◽  
Vol 39 (4) ◽  
pp. 681-687 ◽  
Author(s):  
Olaf Lorbach ◽  
Matthias Kieb ◽  
Mirco Herbort ◽  
Imke Weyers ◽  
Michael Raschke ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Anterior Tibial Translation ◽  
Anterior Tibial ◽  
Anterior Cruciate ◽  
Tibial Translation ◽  
Deficient Knee

Detailed Cadaveric Simulation of Landing Reveals Timing Sequence of Multi-Planar Knee Kinematics: Implications for ACL Injury

2013 ◽  
Author(s):  
A. M. Kiapour ◽  
C. E. Quatman ◽  
V. K. Goel ◽  
S. C. Wordeman ◽  
T. E. Hewett ◽  
...  
Keyword(s):  
Injury Risk ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Acl Injury ◽  
The United States ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Acl Injuries ◽  
Cadaveric Simulation ◽  
Tibial Translation

Over 120,000 anterior cruciate ligament (ACL) injuries occur annually in the United States, mainly affecting the young athletic population. Non-contact injuries are reported to be the predominant mechanism of ACL injury (>70% of ACL injuries), which often occur during landing with high ground reaction forces, muscle forces and segmental inertia. An improved understanding of the mechanisms underlying non-contact ACL injury and inciting events can be used to improve current prevention strategies and decrease the risk of early-onset osteoarthritis. Previous biomechanical and video analysis studies have demonstrated that anterior tibial translation (ATT), knee valgus and internal tibial rotation (ITR) are associated with non-contact ACL injuries [1–3]. While the effects of these factors on ACL injury risk have been extensively studied, there is still controversy and debate about the timing in which these motions occur and reach maximum values during a jump landing task. The current study aimed to investigate interactions between tibio-femoral joint kinematics and ACL strain through a detailed cadaveric simulation of the knee biomechanical response during landing from a jump. For this purpose, instrumented cadaveric limbs were used to simulate bi-pedal landing following a jump utilizing a novel testing apparatus.

Dynamic Restraints of the Medial Side of the Knee: The Semimembranosus Corner Revisited

2019 ◽  
Vol 47 (4) ◽  
pp. 863-869 ◽  
Author(s):  
Christoph Kittl ◽  
Deborah K. Becker ◽  
Michael J. Raschke ◽  
Marcus Müller ◽  
Guido Wierer ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Medial Collateral Ligament ◽  
External Rotation ◽  
Optical Tracking ◽  
Anterior Tibial Translation ◽  
Collateral Ligament ◽  
Posterior Oblique Ligament ◽  
Medial Knee ◽  
Medial Side ◽  
Tibial Translation

Background: Little is known about the dynamic restraints of the semimembranosus muscle (SM). Purpose and Hypothesis: The goal of the present study was to elucidate the role of (1) passive and (2) active restraints to medial-side instability and to analyze (3) the corresponding tightening of the posteromedial structures by loading the SM. It was hypothesized that points 1 to 3 will significantly restrain medial knee instability. This will aid in understanding the synergistic effect of the semimembranosus corner. Study Design: Controlled laboratory study. Methods: Nine knees were tested in a 6 degrees of freedom robotic setup and an optical tracking system. External rotation (ER; 4 N·m), internal rotation (4 N·m), anteromedial rotation (4-N·m ER and 89-N anterior tibial translation), and valgus rotation (8 N·m) were applied at 0°, 30°, 60°, and 90°, with and without an SM load of 75 N. Sequential cutting of the medial collateral ligament and posterior oblique ligament was then performed. At the intact state of the knee and after each cut, the aforementioned simulated laxity tests were performed. Results: The medial collateral ligament was found to be the main passive stabilizer to ER and anteromedial rotation, resulting in 9.3° ± 6.8° ( P < .05), 8.1° ± 3.6° ( P < .05), and 7.6° ± 4.2° ( P < .05) at 30°, 60°, and 90°, respectively. Conversely, after the posterior oblique ligament was cut, internal rotation instability increased significantly at early flexion angles (9.3° ± 3.2° at 0° and 5.2° ± 1.1 at 30°). Loading the SM had an overall effect on restraining ER ( P < .001) and anteromedial rotation ( P < .001). This increased with flexion angle and sectioning of the medial structures and resulted in a pooled 2.8° ± 1.7° (not significant), 5.4° ± 2° ( P < .01), 7.5° ± 2.8° ( P < .001), and 8.3° ± 4.4° ( P < .001) at 0°, 30°, 60°, and 90° when compared with the unloaded state. Conclusion: The SM was found to be a main active restraint to ER and anteromedial rotation, especially at higher flexion angles and in absence of the main passive medial restraints. The calculated tensioning effect was small in all flexion angles for all simulated laxity tests. Clinical Relevance: A complete semimembranosus avulsion may indicate severe medial knee injury, and refixation should be considered in multiligament injury.

Isolated Sectioning of the Medial and Posteromedial Capsular Ligaments in the Posterior Cruciate Ligament-Deficient Knee

1998 ◽  
Vol 26 (3) ◽  
pp. 389-394 ◽  
Author(s):  
Joseph R. Ritchie ◽  
John A. Bergfeld ◽  
Helen Kambic ◽  
Timothy Manning
Keyword(s):  
Posterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Tibial Rotation ◽  
Collateral Ligament ◽  
Superficial Medial Collateral Ligament ◽  
Posterior Translation ◽  
Internal Tibial Rotation ◽  
Tibial Translation ◽  
Deficient Knee

This study was undertaken to determine the contribution of various structures in the posterior cruciate ligament-deficient knee in resisting posterior tibial translation. With “isolated” injuries to the posterior cruciate ligament, the amount of posterior translation will decrease with the posterior drawer test as the knee is taken from neutral to internal tibial rotation. The present study was performed to conclusively determine the anatomic structure responsible for this clinical observation. The TestStar device was used to perform single-plane posterior drawer tests in 14 cadaveric knee specimens. The tests were performed with the knee in neutral tibial rotation and in 20° of internal tibial rotation. The intact knee was tested and then the knee was tested after sequential sectioning of the meniscofemoral ligaments, the posterior cruciate ligament, the posteromedial capsule, and the superficial medial collateral ligament. With the knee in neutral rotation, posterior translation continued to increase as each structure was sectioned. With the knee in internal tibial rotation, posterior displacement was significantly less than in neutral rotation for each state until the superficial medial collateral ligament was sectioned; posterior translation was increased after its sectioning. Our data demonstrate that the superficial medial collateral ligament is the structure responsible for a decrease in posterior tibial translation in the posterior cruciate ligament-deficient knee.

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